| 引用本文: | 张玲,唐玢,程冲,覃雅倩,唐佳,郭雅彬.控制性卵巢刺激周期地塞米松干预时机与助孕结局的关联性分析[J].中国临床新医学,,():-. |
| zhang ling.控制性卵巢刺激周期地塞米松干预时机与助孕结局的关联性分析[J].中国临床新医学,,():-. |
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| 摘要: |
| 目的:探讨控制性卵巢刺激（Controlled Ovarian Stimulation，COS）期间应用醋酸地塞米松（Dexamethasone，DXM）对抑制扳机前血清孕酮（Progesterone，P）升高的效果，比较不同添加时机对辅助生殖治疗结局的影响。方法:回顾性分析2022年1月至2024年6月于本院首次行体外受精-胚胎移植（In Vitro Fertilization-Embryo Transfer，IVF-ET）、采用卵泡期长效长方案的450例患者资料。根据是否添加DXM分为未添加组（A组，n=117）和DXM干预组（B组，n=333）；B组进一步按添加时机分为早期添加组（B1组，促性腺激素（Gonadotropins，Gn) 启动时添加，n=205）、中期添加组（B2组，Gn使用6天或主导卵泡直径10～14 mm时添加，n=54）、晚添加组（B3组，主导卵泡直径＞16 mm或血清P≥1 ng/ml时添加，n=74）。比较四组一般资料、COS过程指标、实验室指标及临床结局相关指标。结果:四组患者一般资料差异无统计学意义（P＞0.05）。B1组Gn总量与用药天数显著少于A组（P＜0.05）。扳机日，A组E2水平显著低于其余三组，A组与B1组P水平相近且均显著低于B2、B3组（P<0.05）。鲜胚移植率A组（78.63%）和B1组（73.17%）显著优于B2组（59.26%）；B1组临床妊娠率（69.29%）与活产率（56.67%）呈最高趋势，但组间差异无统计学意义（P＞0.05）。结论:在卵泡期长效长方案COS周期中，早期添加DXM可有效控制孕酮水平，减少Gn用量及刺激天数，提高鲜胚移植率，进一步改善辅助生殖结局。 |
| 关键词: 醋酸地塞米松 控制性卵巢刺激 卵泡期长效长方案 孕酮 临床结局 |
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| 基金项目:湖南省自然科学基金-区域联合基金项目（项目编号：2025JJ70646）；常德市科技局指导项目（项目编号：2024ZD246；2024ZD260） |
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| Association between the timing of dexamethasone intervention in controlled ovarian stimulation cycles and assisted reproductive outcomes |
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zhang ling1,2,3,4,5,6
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1.Centre for Reproductive Medicine, Changde 2.Hospital, 3.Xiangya 4.School of Medicine, Central South University（The first people’s hospital of 5.Changde 6.city)
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| Abstract: |
| Objective:?To investigate the effect of dexamethasone acetate (DXM) on suppressing premature serum progesterone (P) elevation during controlled ovarian stimulation (COS) and compare the impact of different intervention timings on assisted reproductive outcomes.?Methods: A retrospective analysis was conducted on 450 patients who underwent their first in vitro fertilization-embryo transfer (IVF-ET) using the long-acting follicular phase long protocol from January 2022 to June 2024. Patients were divided into a non-intervention group (Group A, n=117) and a DXM intervention group (Group B, n=333). Group B was further subdivided based on the timing of DXM addition: early addition (Group B1, added at Gn initiation, n=205), mid addition (Group B2, added after 6 days of Gn use or when the leading follicle diameter reached 10-14 mm, n=54), and late addition (Group B3, added when the leading follicle diameter >16 mm or serum P ≥1 ng/ml, n=74). General characteristics, COS parameters, laboratory indicators, and clinical outcomes were compared among the four groups.?Results:No statistically significant differences were found in general characteristics among the four groups (P > 0.05). The total Gn dosage and duration of stimulation in Group B1 were significantly lower than those in Group A (P < 0.05). On the trigger day, serum estradiol (E2) levels in Group A were significantly lower than those in the other three groups. Serum P levels in Groups A and B1 were similar and both were significantly lower than those in Groups B2 and B3 (P < 0.05). The fresh embryo transfer rate in Group A (78.63%) and Group B1 (73.17%) was significantly higher than that in Group B2 (59.26%). Group B1 showed the highest trend in clinical pregnancy rate (69.29%) and live birth rate (56.67%), but the differences between groups were not statistically significant (P > 0.05).?Conclusion： In COS cycles using the long-acting follicular phase long protocol, early addition of DXM can effectively control progesterone levels, reduce Gn dosage and stimulation duration, and increase the fresh embryo transfer rate, thereby potentially improving assisted reproductive outcomes. |
| Key words: Dexamethasone acetate Controlled ovarian stimulation Long-acting follicular phase long protocol Progesterone Clinical outcome |
